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Veterans Health Administration transitional work experience vs. job placement in veterans with co-morbid substance use and non-psychotic psychiatric disorders (Penk et al. 2010)

Absence of conflict of interest.

Citation

Penk, W., Drebing, C.E., Rosenheck, R.A., Krebs, C., Van Ormer, A., & Mueller, L. (2010). Veterans Health Administration transitional work experience vs. job placement in veterans with co-morbid substance use and non-psychotic psychiatric disorders. Psychiatric Rehabilitation Journal, 33(4), 297-307.

Highlights

  • The study ’s objective was to examine the impact of a transitional work experience (TWE) program, within the Veterans Health Administration’s (VHA’s) Compensated Work Therapy (CWT) program, on outcomes related to employment and earnings for veterans with certain psychiatric diagnoses and substance use disorders.
  • The study used a randomized controlled trial design and compared treatment and control groups on self-reported employment and earnings outcomes, which were collected 6 and 12 months after enrollment in the study.
  • The study found that those who participated in TWE (the treatment group) worked more total hours and more weeks, and earned more income, over the 12-month period than the control group.
  • The quality of causal evidence presented in this report is low for employment and earnings outcomes because the randomized controlled trial design was compromised and authors did not account for existing differences between the treatment and control groups. This means we are not confident that the estimated effects are attributable to the transitional work experience program; other factors are likely to have contributed.

Intervention Examined

The Compensated Work Therapy transitional work experience program

Features of the Intervention

The TWE program provides services at approximately 100 Veterans Affairs (VA) medical centers across the United States and serves more than 10,000 veterans per year. Veterans must be referred by a health care provider to be eligible to participate. The TWE program places participants in structured work settings such as VA facilities or private companies; within these placements, participants are paid by the CWT program and receive on- or off-site job coaching from program staff members. TWE staff also help participants set goals for competitive employment and support their job search process.

Features of the Study

The authors compared employment and earnings outcomes of participants randomly assigned to either the TWE program in Bedford, Massachusetts, or to traditional job placement vocational services, which were offered through two state vocational rehabilitation specialists in Lowell and Boston, Massachusetts. The study focused on a sample of 89 participants: 50 in the treatment and 39 in the comparison group. Outcome data were self-reported by respondents and collected by study researchers 6 and 12 months after enrollment in the study. The study compared outcomes for the two groups using statistical tests.

Findings

Employment

  • The TWE group worked more hours and more weeks than the control group over the 12-month study follow-up period. These differences were statistically significant.

Earnings

  • The TWE group earned more income than the control group over the 12-month study follow-up period. This difference was statistically significant.

Considerations for Interpreting the Findings

Although the study used a randomized controlled trial design, the authors excluded data from sample members who switched conditions during the follow-up period. Excluding these individuals compromised the experimental design of the study, and the authors did not account for existing differences between the treatment and control groups when estimating impacts on employment and earnings outcomes. These existing differences, and not the TWE program, could account for the differences in outcomes.

Causal Evidence Rating

The quality of causal evidence presented in this report is low because the randomized controlled trial design was compromised and authors did not account for existing differences between the treatment and control groups. This means we are not confident that the estimated effects are attributable to the transitional work experience program; other factors are likely to have contributed.

Reviewed by CLEAR

February 2020

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